Rosendale takes aim at drug-benefit managers

Posted at 5:00 PM, Jun 20, 2018
and last updated 2018-06-20 19:00:31-04

State Auditor Matt Rosendale took action Wednesday against a pair of prescription drug-benefit managers, saying the companies must reveal more information about how they do business and influence drug prices in Montana.

Rosendale, whose office regulates health insurance, said the multibillion-dollar companies could be fined for operating without a state license – and can’t obtain one unless they provide the information.

He said Wednesday’s action is part of his efforts to create more “transparency” for medical and health-insurance prices, to help reduce health-care costs.

“If we can shed more light on these transactions, we’re going to be able to help drive the cost of pharmaceuticals down,” he told MTN News. “The pharmacy-benefit managers have had control over this industry like a cartel, and they feel like they don’t have to answer to anybody.

“And we, in my office, are going to make sure that they do not treat the consumers of Montana in that fashion.”

Rosendale is the Republican candidate for U.S. Senate in Montana, challenging Democratic U.S. Sen. Jon Tester.

Rosendale’s office filed actions Wednesday against Prime Therapeutics, which is the pharmacy-benefit manager, or PBM, for Blue Cross and Blue Shield of Montana, the largest health insurer in the state, and Aetna Health of Utah and two other firms, which performed drug-management services for the Montana Health Co-op.

The actions said the companies have been operating in Montana without a license since 2013.

The companies have 21 days to respond. They can dispute the claim, ask for a hearing or settle the case.

“They’re multibillion-dollar companies that control that industry,” Rosendale said. “And as we try to get more information from those entities to determine exactly how they were working here in Montana, they refused to cooperate.”

A spokeswoman for Prime Therapeutics said it’s been working with Rosendale on his information requests and “will continue to work toward a resolution on this issue.” The other companies said they’re reviewing the complaint and will “defend ourselves vigorously.”

Rosendale said he’s had complaints from both consumers and pharmacists about PBMs and how they act to influence drug prices or prevent consumers from getting information on drug prices.

He said one complaint said a PBM contract prohibited pharmacists from telling consumers that they could pay less by paying cash for the drug, rather than using their health coverage.

Rosendale’s office said it won’t license the firms unless they provide more information about their business practices in Montana – and if they don’t have a license, they can be subject to fines of up to $25,000 per violation.

The complaint said each claim or transaction conducted by the company without a license is a separate violation – and that Prime Therapeutics has made nearly 6 million claims from January 2013 to April 2018.